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Being the Director of nursing, I must be in charge of all financial and budgeting processes of our medical center. I am aware of the fact that central functioning can be sustained through effective analysis of revenues, expenditures, and reimbursements. Due to the fact that my center specializes in cosmetic reconstruction, insurance is not acceptable for most medical procedures held and, as a result, the reimbursement level is quite low.
Our organizations strive to compensate for this shortage of insurance and reimbursement by introducing alternative methods for increasing patients’ safety and security. Because quality standards are high, our center does not have serious problems with insurance. Nonetheless, financial responsibility for the medical service is still taken to eliminate contingencies and introduce excellence to the process of health care delivery. In this respect, my major financial responsibility implies greater involvement in distributing financial resources effectively to ensure the appropriate level of services. I am especially concerned with the level of technological advancement and, therefore, the major part of financial resources is directed at creating a reputable image of the state-of-the-art center. Our patients, therefore, can be sure of the quality and advances of our health care.
Identifying Primary Payers of the Organization
Because our organization provides outpatient health care, our access to financial sources and insurance issues are limited. This is of particular concern to plastic surgery which does not belong to disease management. In this respect, the primary payers of our organization are the patients who want to receive service of the highest level. With regard to this, most of our financial resources are invested to improve the technological sphere and enhance the competence of our nurse professionals. Second, the hospital itself is the main provider of financial resources for sustaining the normal functioning and competitive development of the center. Indeed, the financial input is drawn from the profits and revenues that contribute to the excellence of medical care. Third, the suppliers of the equipment are also potential providers of quality and care (Finkler et al., 2007). Therefore, because our organization is responsible for delivering a high level of safety, our equipment providers should also reimburse any defects.
Payer Mix for the Organization’s Total Revenue
According to Rauscher and Wheeler (2010), hospitals with a higher level of Medicaid payer mix gather a great number of patient care revenues that are privately insured by self-paid patients. On the other hand, self-pay patients have the option while paying directly for the services, including fee schedule and percentage rates (Cohn et al., 2008). In this respect, private and outpatient organizations have the highest percentage of revenues from self-pay patients (Marshall & Coughlin, 2010). In this respect, this is the target group for private medical establishments.
While considering the payer mix in our organization, it should be stressed it is the main attribute of the self-pay patients covering the highest percentage of revenues. The second source of revenue comes from Medicaid which controls and supports all the processes held in the organization. This percentage amounts to about 30 % of all revenues. Other resources are insignificant and they cover less than 5 %. In order to attract other resources, our organization strives to introduce a high level of services. In general, the current system of incoming payments is effective because our center has been successfully modernized and improved in technological terms.
References
Cohn, K. H., & Hough D. E. (2008). The Business of Health Care. Connecticut: Greenwood Publishing Group.
Finkler, S. A., Kovner, C. T., & Jones, C. B. (2007). Financial management for nurse managers and executives (3rd ed.). Philadelphia: Saunders.
Marshall, E., & Coughlin, J. F. (2010). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader. NY: Springer Publishing Company.
Rauscher, S., & Wheeler, J. R. (2010). Hospital revenue cycle management and payer mix; do Medicare and Medicaid undermine hospitals’ ability to genera and collect patient care revenue? Journal of Health Care Finance. 37(2), 81-96.